ICU story

December 14, 2014

Rites of Passage

ID: 50 year old man with hairy cell leukemia transferred to ICU for treatment of pneumonia.

Lives with wife and two daughters. Works as CEO of bank.

Mr. Goshen is wheeled into the Intensive Care Unit. His skeletal body is encased in thin yellowish skin, draped with white sheets. With him is a balding white-coated man and his bearded colleague, wearing a white shirt, blue tie, jeans and pointy cowboy boots. As the nurse moves the stretcher to a corner, they approach our white-coated entourage during our morning rounds. The resident’s recitation of numbers describing bed number two’s bodily functions is aborted, “We need to talk about Andrew Goshen.”

Our little circle breaks as we turn to exit single file, into a dingy space of pink vinyl sofas. “Family Room” says the sign outside.

So far, working at the ICU has been okay. Each day, I visit my assigned patient, an eighty year old, white haired woman who is having a hard time weaning off a respirator. She still needs a tube down her throat and taped to her lips, to help her breath. I do my head-to-toe medical student exam each day, then record digits in various tables. I ask her questions. She nods her head or blinks her eyes.

Before her, I’ve monitored less interactive patients. A jaundiced man in his fifties, withering away and swelling up due to hepatitis; a twenty year old, HIV positive, heroine addict rescued from a house fire, his body mottled with “cherry red” lesions of carbon monoxide poisoning.

Each morning I arrive at the ICU to see what type of cookies the nurses have left in the staff room and which beds are surrounded by a curtain. Soon uniformed men show up, go behind the curtain, emerging to wheel away a gurney transporting a long white zippered plastic bag, like a tarp-covered log.

* *

“How was your day?” asks my father at dinner. My parents are visiting from Toronto this week.

“Okay,” I reply. “Interesting.”

“What did you do?” inquires my mother.

* *

In the Family Room, we take our places around two fatigued-looking women on the sofa. One has her hand on the other’s shoulder, face turned to whisper to her couch-mate’s bowed head. Dr. Lindsey, the balding one, sits in a chair next to her, with a worried frown.

My attending, Dr. Hardy, is next to him, The young “team”, is scattered about the room, standing beside and behind furniture. I am leaning against the doorpost. The bearded cowboy, Dr. Jones, paces across the room, stops and puts a foot on one of the sofa’s chrome arm-rails.

“We’ve won against the odds. The cancer is licked. He got through the hard part and he’s cured,” he caresses his tie. “Just have to get through this pneumonia.”

“He’s so frail. The chemo took a toll on his defenses,” the older Dr. Lindsey shakes his head. “He’s still very sick.”

“True, but he’s very young,” says Dr. Jones, the cancer doctor. “He has some fight left in him. I say we push to keep him going. Do whatever we need to do to get him over this last hump. What do you think, Mrs. Goshen?”

“The woman on the couch looks up, her eyes heavy as she glances at the “players” around her, “I guess you’re right.”

We file out of the room and resume the morning rounds. Back to bed number two’s vital statistics. There are various white-coated doctor people wandering through, asking about Mr. Goshen’s PO2 and BP as they glance a look at his skull-like face. Occasionally, one would go over to his bedside to ask, “How are you doing, Mr. Goshen?”, add “good, good” when he seems to nod in reply, and wander away.

A long piercing shrill shoots through the steady orchestral melody of ICU beeps. Suddenly, the resident is by Mr. Goshen’s bed waving me away to make room for the crash cart being wheeled toward the bedside.

This scene continues, full of jolts, beeps, injections, apologies to Andy, people pushing down on his bony chest in the bobbing of CPR. Dr. Hardy and I stand in the corner, at Mr. Goshen’s foot – he, watching the heart monitor and barking out names and doses of drugs in response to blood pressure announcements, me, trying to stay out of the way.

Until a nurse points at me, “Take over.”

I am now out of the audience, onto the stage. I push up my sleeves, place two fingers at the junction of his ribs and lay my palm above this, scolding myself for cringing as I feel slime between his chest hairs.

“Get up on the bed!” someone yells. I scramble onto the mattress, straddle the bones under me, and repeatmy landmarking routine. Looking down, I count, “One and two and three and four and five and. . . “, pushing rhythmically, trying to ignore the crackles of ribs breaking under my efforts and filing away the fear that I will crush the heart below this sternum. Just don’t look at his face. Just count. Just push. Don’t think. Breathe. Don’t screw up. Count. Push. Go. Keep going. Don’t stop. Don’t look.

“Okay, get off,” I comply and stepped away. More jolts. More “Sorry Andy!” ‘s. More blood pressures. More injections. Nothing seems to be helping.

Murmurs about fluid in his lung escalate. A green package is placed in front of the resident. He rips it open, takes out a long plastic tube and pierces Mr. Goshen’s side, triggering a gush of fluid all over the floor.

“Do the other side!” Chest tube number two. (“Sorry, Andy!”) Another geiser.

Blood pressure still dropping.

“Paracentesis!”

The resident responds. A narrow tube stabs the centre of Mr. Goshen’s chest.

“Get an echo!” yells Dr. Hardy. An echo? “If his left ventricle is still working, we still have a chance!” We do? He does? I look at the fried, stabbed body before me and the plastic protruding from it. We stare at the motionless blobs on the TV monitor. Dr. Hardy rubs his chin, “Okay, that’s it.”

The Team collects in a narrow room, sitting in a row, side by side along the wall, staring at the floor.The nurses pull the curtains around Mr. Goshen’s bed and open them once some of the tubes had been removed. The woman and her two teenage daughters huddling next to her are escorted into the room. One of the girls sobs the moment she sees the corpse before her. The threesome shuffle to the bedside.

I look down, like my colleagues. There was no way to hide from their wailing.

“Sometimes things can get emotional,” would be Dr. Hardy’s pep talk the next day.

* *

I go home. I wish Matt was here, not in New York at his conference. I sit down to eat supper. My mom comes in and asks about my day. “Not so good.” “W’hat happened?” “A lot”. She frowns and points to the worn-down soles of my loafers. “A doctor should wear decent shoes. Can’t you even buy some shoes? How can you walk in those things? Don’t they throw you out of the hospital with shoes like that?”

I don’t reply. I look down at my plate, picking at my spinach, shredding it into green strips. She leaves the kitchen.

I slide off the chair and crumple up on the kitchen floor. The coolness of the tile against my cheek soothes me as I bring my knees to my chest and hide my head into the curve I have created.

The next day, Mom insists she drive me to work. She rants about my shoes and my irresponsiblity for not picking up my reading glasses from the optometrist’s office. She is interrupted by my explosion. “WHAT do you want from my life? You’re nagging me about shoes and glasses while I go to work everyday and watch people die!”, I sob.

We arrive at our destination. My mother is silent. I fumble for the door-handle, climb out and slam the car door. Dizzy and disoriented by a curtain of tears dripping from my eyes, I stumble toward the nearest hospital door. “Stupid shoes,” I mutter, angered by the accuracy of my mother’s appraisal of them. My coat clutched in one hand, knapsack slung over my shoulder, I rush down the stark pale-yellow walled, linoleum tiled hallway.